Provider Demographics
NPI:1700971207
Name:PEREZ-LACEY, CATALINA (MD)
Entity Type:Individual
Prefix:
First Name:CATALINA
Middle Name:
Last Name:PEREZ-LACEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB #375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:7 CASA DEL ORO WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8290
Practice Address - Country:US
Practice Address - Phone:505-466-8428
Practice Address - Fax:505-466-8428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM882432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0450OtherBCBS
NM16576Medicaid
NM0450OtherBCBS